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Cementless total hip arthroplasty for osteonecrosis of the femoral head in systemic lupus erythematosus: a study with 10–16 years of follow-up

  • Original Article
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European Orthopaedics and Traumatology

Abstract

Objectives

The purpose of the present study was to describe the long-term results of total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE).

Methods

From 1994 to 2001, 18 cementless THAs (14 SLE patients) were included in the present study. Four hips (three patients) were lost to follow-up. The remaining 14 hips (11 patients) were available for evaluation. The mean follow-up period was 13.1 (range, 10.0–16.4) years. The follow-up rate was 77.8 %. The mean age at the time of surgery was 35.2 (range, 27.4–51.0) years.

Results

Mean preoperative Harris Hip Score was 37.4 (range, 17.1–63.1) points, which improved to 94.5 (range, 73.9–100) points at final follow-up. Two hips had dislocation and were treated successfully with closed reduction. No patient in this study group had deep venous thrombosis or pulmonary embolism. One hip had peroneal nerve palsy. No superficial or deep wound infection was observed. Two hips of two patients required reoperation due to dislodgement of a polyethylene insert. With revision of the acetabular component for any reason considered to be a failure, the 10-year survival rate was 93 % (95 % CI, 0.79–1).

Conclusion

We have reported the long-term results of THA for ONFH with SLE. Although several reports have noted that the results of THA for ONFH are less favorable than those for osteoarthritis, the long-term results of THA for ONFH with SLE were acceptable. THA is an acceptable option for patients with advanced-stage or an extended region of ONFH.

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References

  1. Merrell M, Shulman LE (1955) Determination of prognosis in chronic disease, illustrated by systemic lupus erythematosus. J Chronic Dis 1:12–32

    Article  PubMed  CAS  Google Scholar 

  2. Gripenberg M, Helve T (1991) Outcome of systemic lupus erythematosus. A study of 66 patients over 7 years with special reference to the predictive value of anti-DNA antibody determinations. Scand J Rheumatol 20:104–109

    Article  PubMed  CAS  Google Scholar 

  3. Kasitanon N, Magder LS, Petri M (2006) Predictors of survival in systemic lupus erythematosus. Medicine (Baltimore) 85:147–156

    Article  Google Scholar 

  4. Cervera R, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Kiss E, Zeher MM, Tincani A, Kontopoulou-Griva I, Galeazzi M, Bellisai F, Meroni PL, Derksen RH, de Groot PG, Gromnica-Ihle E, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quéré I, Hachulla E, Vasconcelos C, Roch B, Fernández-Nebro A, Piette JC, Espinosa G, Bucciarelli S, Pisoni CN, Bertolaccini ML, Boffa MC, Hughes GR, Euro-Phospholipid Project Group (European Forum on Antiphospholipid Antibodies) (2009) Morbidity and mortality in the antiphospholipid syndrome during a 5-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis 68:1428–1432

    Article  PubMed  CAS  Google Scholar 

  5. Oinuma K, Harada Y, Nawata Y, Takabayashi K, Abe I, Kamikawa K, Moriya H (2001) Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Dis 60(12):1145–1148

    Article  PubMed  CAS  Google Scholar 

  6. Maistrelli G, Fusco U, Avai A, Bombelli R (1988) Osteonecrosis of the hip treated by intertrochanteric osteotomy. A four- to 15-year follow-up. J Bone Joint Surg Br 70:761–766

    PubMed  CAS  Google Scholar 

  7. Jacobs MA, Hungerford DS, Krackow KA (1989) Intertrochanteric osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg Br 71:200–204

    PubMed  CAS  Google Scholar 

  8. Mont MA, Fairbank AC, Krackow KA, Hungerford DS (1996) Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Am 78:1032–1038

    PubMed  CAS  Google Scholar 

  9. Sakano S, Hasegawa Y, Torii Y, Kawasaki M, Ishiguro N (2004) Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br 86:359–365

    Article  PubMed  CAS  Google Scholar 

  10. Sugioka Y (1978) Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res 130:191–201

    PubMed  Google Scholar 

  11. Tooke SM, Amstutz HC, Hedley AK (1987) Results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. Clin Orthop Relat Res 224:150–157

    PubMed  Google Scholar 

  12. Masuda T, Matsuno T, Hasegawa I, Kanno T, Ichioka Y, Kaneda K (1988) Results of transtrochanteric rotational osteotomy for nontraumatic osteonecrosis of the femoral head. Clin Orthop Relat Res 228:69–74

    PubMed  Google Scholar 

  13. Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop Relat Res 277:111–120

    PubMed  Google Scholar 

  14. Sugioka Y, Yamamoto T (2008) Transtrochanteric posterior rotational osteotomy for osteonecrosis. Clin Orthop Relat Res 466:1104–1109

    Article  PubMed  Google Scholar 

  15. Ikemura S, Yamamoto T, Nakashima Y, Mawatari T, Motomura G, Iwamoto Y (2009) Transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients 20 years or younger. J Pediatr Orthop 29:219–223

    Article  PubMed  Google Scholar 

  16. Yamamoto T, Ikemura S, Iwamoto Y, Sugioka Y (2010) The repair process of osteonecrosis after a transtrochanteric rotational osteotomy. Clin Orthop Relat Res 468:3186–3191

    Article  PubMed  Google Scholar 

  17. Motomura G, Yamamoto T, Suenaga K, Nakashima Y, Mawatari T, Ikemura S, Iwamoto Y (2010) Long-term outcome of transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients with systemic lupus erythematosus. Lupus 19:860–865

    Article  PubMed  CAS  Google Scholar 

  18. Iwata H, Torii S, Hasegawa Y, Itoh H, Mizuno M, Genda E, Kataoka Y (1993) Indications and results of vascularized pedicle iliac bone graft in avascular necrosis of the femoral head. Clin Orthop Relat Res 295:281–288

    PubMed  Google Scholar 

  19. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am 77:681–694

    PubMed  CAS  Google Scholar 

  20. Sotereanos DG, Plakseychuk AY, Rubash HE (1997) Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res 344:243–256

    Article  PubMed  Google Scholar 

  21. Hasegawa Y, Iwata H, Torii S, Iwase T, Kawamoto K, Iwasada S (1997) Vascularized pedicle bone-grafting for nontraumatic avascular necrosis of the femoral head. A 5- to 11-year follow-up. Arch Orthop Trauma Surg 116:251–258

    Article  PubMed  CAS  Google Scholar 

  22. Eisenschenk A, Lautenbach M, Schwetlick G, Weber U (2001) Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop Relat Res 386:100–105

    Article  PubMed  Google Scholar 

  23. Judet H, Gilbert A (2001) Long-term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res 386:114–119

    Article  PubMed  Google Scholar 

  24. Prupas HM, Patzakis M, Quismorio FP Jr (1981) Total hip arthroplasty for avascular necrosis of the femur in systemic lupus erythematosus. Clin Orthop Relat Res (161):186–90

  25. Hanssen AD, Cabanela ME, Michet CJ Jr (1987) Hip arthroplasty in patients with systemic lupus erythematosus. J Bone Joint Surg Am 69(6):807–814

    PubMed  CAS  Google Scholar 

  26. Zangger P, Gladman DD, Urowitz MB, Bogoch ER (2000) Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus. J Rheumatol 27:919–923

    PubMed  CAS  Google Scholar 

  27. Ito H, Matsuno T, Hirayama T, Tanino H, Minami A (2007) Health-related quality of life in patients with systemic lupus erythematosus after medium to long-term follow-up of hip arthroplasty. Lupus 16:318–323

    Article  PubMed  CAS  Google Scholar 

  28. Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K (2002) The 2001 revised criteria for diagnosis, classification, and staging of idiopathic ON of the femoral head. J Orthop Sci 7:601–605

    Article  PubMed  Google Scholar 

  29. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg Br 64:17–19

    PubMed  CAS  Google Scholar 

  30. Dall D (1986) Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach. J Bone Joint Surg Br 68(3):382–386

    PubMed  CAS  Google Scholar 

  31. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755

    PubMed  CAS  Google Scholar 

  32. Chong RW, Chong CS, Lai CH (2010) Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties. Int J Rheum Dis 13(3):235–239

    Article  PubMed  Google Scholar 

  33. Johannson HR, Zywiel MG, Marker DR, Jones LC, McGrath MS, Mont MA (2011) Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review. Int Orthop 35(4):465–473, Epub 2010 Feb 25

    Article  PubMed  Google Scholar 

  34. Radl R, Hungerford M, Materna W, Rehak P, Windhager R (2005) Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthrosis. Acta Orthop 76(1):49–55

    Article  PubMed  Google Scholar 

  35. Saito S, Saito M, Nishina T, Ohzono K, Ono K (1989) Long-term results of total hip arthroplasty for osteonecrosis of the femoral head. A comparison with osteoarthritis. Clin Orthop Relat Res 244:198–207

    PubMed  Google Scholar 

  36. Ortiguera CJ, Pulliam IT, Cabanela ME (1999) Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term follow-up. J Arthroplasty 14:21–28

    Article  PubMed  CAS  Google Scholar 

  37. Radl R, Egner S, Hungerford M, Rehak P, Windhager R (2005) Survival of cementless femoral components after osteonecrosis of the femoral head with different etiologies. J Arthroplasty 20(4):509–515

    Article  PubMed  Google Scholar 

  38. Phillips CB, Barrett JA, Losina E, Mahomed NN, Lingard EA, Guadagnoli E, Baron JA, Harris WH, Poss R, Katz JN (2003) Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am 85:20–26

    Article  PubMed  Google Scholar 

  39. Blom AW, Taylor AH, Pattison G, Whitehouse S, Bannister GC (2003) Infection after total hip arthroplasty. The Avon experience. J Bone Joint Surg Br 85(7):956–959

    Article  PubMed  CAS  Google Scholar 

  40. Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA (2003) Rates and outcomes of primary and revision total hip replacement in the US medicare population. J Bone Joint Surg Am 85-A(1):27–32

    PubMed  Google Scholar 

  41. Eftekhar NS (1976) Dislocation and instability complicating low friction arthroplasty of the hip joint. Clin Orthop Relat Res 121:120–125

    PubMed  Google Scholar 

  42. Ritter MA (1976) Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res 121:92–94

    PubMed  Google Scholar 

  43. Etienne A, Cupic Z, Charnley J (1978) Postoperative dislocation after Charnley low-friction arthroplasty. Clin Orthop Relat Res 132:19–23

    PubMed  Google Scholar 

  44. Ali Khan MA, Brakenbury PH, Reynolds IS (1981) Dislocation following total hip replacement. J Bone Joint Surg Br 63:214–218

    PubMed  Google Scholar 

  45. Morrey BF (1992) Instability after total hip arthroplasty. Orthop Clin North Am 23:237–248

    PubMed  CAS  Google Scholar 

  46. Khatod M, Barber T, Paxton E, Namba R, Fithian D (2006) An analysis of the risk of hip dislocation with a contemporary total joint registry. Clin Orthop Relat Res 447:19–23

    Article  PubMed  Google Scholar 

  47. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220

    PubMed  CAS  Google Scholar 

  48. Sugano N, Nishii T, Miki H, Yoshikawa H, Sato Y, Tamura S (2007) Mid-term results of cementless total hip replacement using a ceramic-on-ceramic bearing with and without computer navigation. J Bone Joint Surg Br 89:455–460

    Article  PubMed  CAS  Google Scholar 

  49. Ho KW, Whitwell GS, Young SK (2012) Reducing the rate of early primary hip dislocation by combining a change in surgical technique and an increase in femoral head diameter to 36 mm. Arch Orthop Trauma Surg. In press

  50. Bistolfi A, Crova M, Rosso F, Titolo P, Ventura S, Massazza G (2011) Dislocation rate after hip arthroplasty within the first postoperative year: 36 mm versus 28 mm femoral heads. Hip Int 21(5):559–564. doi:10.5301/HIP.2011.8647

    Article  PubMed  Google Scholar 

  51. Berry DJ, von Knoch M, Schleck CD, Harmsen WS (2005) Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 87(11):2456–2463

    Article  PubMed  Google Scholar 

  52. Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, Meek RM, Reed MR (2011) Lower rates of dislocation with increased femoral head size after primary total hip replacement: a five-year analysis of NHS patients in England. J Bone Joint Surg Br 93(7):876–880

    Article  PubMed  CAS  Google Scholar 

  53. Kawasaki M, Hasegawa Y, Sakano S, Masui T, Ishiguro N (2005) Total hip arthroplasty after failed transtrochanteric rotational osteotomy for avascular necrosis of the femoral head. J Arthroplasty 20(5):574–579

    Article  PubMed  Google Scholar 

  54. Lee YK, Ha YC, Kim KC, Yoo JJ, Koo KH (2009) Total hip arthroplasty after previous transtrochanteric anterior rotational osteotomy for femoral head osteonecrosis. J Arthroplasty 24(8):1205–1209, Epub 2009 Jun 12

    Article  PubMed  Google Scholar 

  55. Orban H, Cîrstoiu C, Adam R (2007) Total hip arthroplasty in secondary systemic lupus erythematosus femoral head avascular necrosis. Rom J Intern Med 45(1):123–129, Review

    PubMed  CAS  Google Scholar 

  56. Smiłowicz M, Kowalczewski JB (2005) Long term results after total hip replacement—cemented and cementless in young rheumatic patients. Chir Narzadow Ruchu Ortop Pol 70(5):319–323, Polish

    PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan

    Tomonori Shigemura, Shunji Kishida, Junichi Nakamura & Kazuhisa Takahashi

  2. Department of Orthopaedic Surgery, Matsudo City Hospital, Matsudo, Japan

    Satoshi Iida

  3. Funabashi Orthopaedic Hospital, Funabashi, Japan

    Kazuhiro Oinuma

  4. Department of Orthopaedic Surgery, Chibaken Saiseikai Narashino Hospital, Narashino, Japan

    Yoshitada Harada

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  1. Tomonori Shigemura
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  2. Shunji Kishida
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  3. Satoshi Iida
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  4. Kazuhiro Oinuma
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Correspondence to Tomonori Shigemura.

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Shigemura, T., Kishida, S., Iida, S. et al. Cementless total hip arthroplasty for osteonecrosis of the femoral head in systemic lupus erythematosus: a study with 10–16 years of follow-up. Eur Orthop Traumatol 4, 15–20 (2013). https://doi.org/10.1007/s12570-012-0149-z

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  • DOI: https://doi.org/10.1007/s12570-012-0149-z

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